Provider Demographics
NPI:1245999846
Name:RODRIGUEZ CALES, JESUS DANIEL (PHD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:DANIEL
Last Name:RODRIGUEZ CALES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 CALLE SAUCO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6718
Mailing Address - Country:US
Mailing Address - Phone:787-239-1134
Mailing Address - Fax:
Practice Address - Street 1:1788 CALLE JULIO AYBAR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4410
Practice Address - Country:US
Practice Address - Phone:787-513-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4332103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical